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Kidney Week

Abstract: PO0177

National Epidemiology of Community-Acquired AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Diamantidis, Clarissa Jonas, Duke University Department of Medicine, Durham, North Carolina, United States
  • Zepel, Lindsay, Duke University Department of Population Health Sciences, Durham, North Carolina, United States
  • Maciejewski, Matthew L., Duke University Department of Population Health Sciences, Durham, North Carolina, United States
  • Burks, Erin E., Duke University Department of Medicine, Durham, North Carolina, United States
  • Brookhart, M. Alan, Duke University Department of Population Health Sciences, Durham, North Carolina, United States
  • Bowling, C. Barrett, Duke University Department of Medicine, Durham, North Carolina, United States
  • Wang, Virginia, Duke University Department of Population Health Sciences, Durham, North Carolina, United States
Background

Community-acquired acute kidney injury (CA-AKI) is AKI that develops outside of the hospital and is the most common form of AKI globally. National estimates of CA-AKI in the US are absent due to lack of integrated health data and limited availability of outpatient lab data. In this study, we leverage data from the Veterans Health Administration (VA) to estimate CA-AKI incidence and risk factors.

Methods

We constructed a retrospective cohort using national VA administrative and lab data to assess the cumulative CA-AKI incidence among active VA primary care users in 2013-2017. Veterans who did not have recorded outpatient serum creatinine (SCr) and those with a history of severe kidney disease (≥ Stage 5 or kidney transplant) were excluded. CA-AKI was defined as ≥ 1.5 fold relative increase in outpatient SCr or inpatient SCr (≤ 24 hours from admission), from a reference value defined as the preceding outpatient SCr ≤ 12 months prior. A Cox model was used to estimate the association between CA-AKI risk and baseline variables capturing socio-demographics and comorbidities, accounting for repeated measurements among Veterans.

Results

Of approximately 2.5 million eligible Veterans in each analysis year, the cumulative incidence of CA-AKI was approximately 2% each year and declined slightly over time (2.0, 2.0, 2.0, 1.9, and 1.6% in 2013-2017, respectively). Of these, 79% were Stage 1 AKI, 15 % were Stage 2, and 6% were Stage 3 across all years. Only 26% of CA-AKI was observed in the inpatient setting. Veterans with CA-AKI (vs. no CA-AKI) more likely to be older, male, Black race, with greater comorbidity. After adjustment, increasing age, female sex, Black race, Hispanic ethnicity, diabetes, heart failure, hypertension, alcohol use, HIV/AIDs, metastatic cancer, and sickle cell anemia were all associated with increased CA-AKI risk (HR >1.15).

Conclusion

CA-AKI affects approximately 1 of every 50 US Veterans and is most common in the outpatient setting, with less than a third observed in the inpatient hospital setting. Reliance on inpatient evaluation of AKI likely results in significant under-recognition and missed opportunity to prevent and manage the substantial long-term consequences of AKI.

Funding

  • NIDDK Support